Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Thursday, July 24, 2008

I do not browse the NPR website because, well, they sound just like TASS or Pravda, but I was alerted to this story by a kind friend. Is there a conservative mole at NPR? If not, they would do well to pull this picture because it makes the story a bit, well, a bit of a farce don't you think? Since they will pull the picture soon I have grabbed it out of the ether to give you the full effect (the 'meat' is in the last paragraph).

Whoa! She's so fat when she lays around the House she lays AROUND the House. Shes so Fat when 2 guys broke into her Apartment she yelled "RAPE!" they yelled "NO!". Shes so fat, her bathtub has Stretch Marks...

Oh come on you guys. This is like kicking a dead dog. They just don't know anybetter. Carbs fill you up faster. And fruit and veggies are not cheap. Odawalla bars cost me a 1.50$.....And if you are looking at organic- forget about it.

I don't think they need public assistance but they need education. The woman in my town who look like that are the minority because most of them are at the gym after they drop the kids off to school in their Land Rover. Guess what they just got lucky too!!! We were born to educated parents. It was not our choice, we just got lucky!

So an article like this makes me grateful I am not a huge black woman on public assistance.

Maybe its just me but I don't need NPR to be grateful I'm not a Fatty on Welfare. We didn't eat no fancy Whole Foods Brown Rice picked by Viet Cong Vets wearing Che Guevera Berets. I went a whole month with a Thermos full of Count Chocola in my Lost in Space Lunchbox and I still looked like an Auschwitz prisoner.

I work part time due to my husband's constant deployments...so I budget for things, including groceries....I walk into the store with a list and I good idea of how much I can spend. In saying that, I was behind a lady in line last week who had a cart FULL of Dr. Pepper, Crush soda, lunchables, fruit roll-ups and mini corn dogs...total being 479$, for which she proudly whipped out her food stamp card and declared "wow, that much, and this will be EBT today"...she paid for her non-food items, such as body wash and swimming pools with money then took her heavily jeweled ass to the parking lot to load the groceries into the EXACT SAME TRUCK I DRIVE....and believe me, I know the payment, and if she can afford that, then I shouldn't be buying her fat children mini corn dogs. Just had to add that, sorry it was a rant!

The picture by itself is kind of sad and so is the story, but you are right, the combination of both is a gem. I usually am a compassionate person, unlike Etotheipi and his December post,(she *runs* and *ducks*)but this is hilarious.

I did some charity work in Jamaica last month. The poor people there are stick thin, and don't wear shades. Maybe we should send a few hundred of our 'poor' people to Jamaica (not the tourist sections...) for a year or so and see how they'd do? I know a few families that'd love to come here and get what these ladies are getting from our government. I bet they'd be off the dole in no time, if given the chance.

As an employer, I couldn't imagine hiring either of these ladies. They look like the types that would spend 1/2 their time being absent 'sick'. At those weights, they can't possibly to the physical work (restaurant, grocery, retail work is mostly on your feet stuff...) they would be qualified for with so little actual education or training.

I don't exactly feel sorry for them, but I think their fatness is just really sad. My Mom has been overweight her whole life, and it's affected her life in every way. It's such a waste of your life to have a body you're ashamed of. How ever can you meet your potential if you're always worried about how your butt looks? Plenty of normal sized women have the same problem. My husband says that one of the things he likes best about me is that I never complain about my body or wish it was different. Imagine if we could harness and use all the mental energy that normal women expend obsessing about their physical "flaws"...Just exercise, eat well and enjoy the body God gave you--especially when you're nekkid.

Notably, we have to ask every ER patient now if they "have enough money for food". If they answer "no", what I'm supposed to do about it is still unclear. I don't have time to explain economics to everyone or "get rid of that freeloading boyfriend" or "go to school" or "sell some of your knick knacks and drug paraphenelia". I want to help people and I can tell anyone who wants to know how to feed two people on $30/week because I did it for three years, but not in the ER, kay?

You fail ecomonics of the urban environment 101. "Do you have enough money for food?" is the wrong question to ask.

"After cigarettes and Wild Irish Rose, how much money do you have left?" If the answer > 0, then they have enough money for food. And let's not discount the caloric quantity of booze.

Asking the question as you are instructed, to the multicultural urban ear, it sounds like this, "How much free food do you want from the hospital?"

You have to ask it in terms that people would understand -- "We have yogurt and baby carrots. Do you want any?" The hungry person will say yes. The bullshitter who sells their EBT for pennies on the dollar will say no. This is how you seperate the wheat from the chaff.

I don't get why people keep arguing that bad food is cheaper, when that's not always the case. I feed a family of 4 for $350 per month. We eat very well (including plenty of meat, cheese, fresh fruits and veggies, yogurt, etc), I'm just very careful about what I buy - always looking for sales, using coupons, buying generic, and such. Recently bought 28 large organic oranges for $6. Just gotta keep your eyes open for the deals.

$350/month for 4 people comes to less than $1 per meal per person for very good food. Which is way the hell cheaper than McDonalds. Or the $3 lunchable.

Look here. Yes, they are fat. High-calorie foods are cheap. They are ignorant. And food is probably one of their only pleasures. A box of Mac N Cheese is cheap but packs a ton of calories.

Minimum wage jobs pay squat. You can't live on them.

These people aren't the brightest bulbs clearly. But if you can only clear $1400 in three months from a minimum wage job (none of these places will let you work full time because then they have to pay you benefits) -- okay, get a second one. Work two jobs that pay $7.00 an hour and take home less than $1000 a month.

Please tell me how you live on that?

Also, if you have a child, please tell me how you live on that and also feed your child? Also, please tell me how you live on that and pay for child care?

This is not a rhetorical question. Most of us have postgraduate degrees so this does not precisely come up, but do these folks have IQs that break 85? What do you do with them?

Produce is extremely expensive. It's the most expensive thing in your shopping cart. Soda is extremely cheap. They're fat because they eat cheap food, are ignorant, probably don't have the most impulse control in the world, but they probably don't spend that much on food.

I'll bet you those of you here with advanced degrees spend more per person on food than these folks do.

It really is a wash between going on public assistance or taking one of these miserable low-paying jobs with no benefits.

These people clearly are not college material.

Please give serious suggestions as to what you would, as a practical matter, want them to do if you could wave a magic wand.

Bear in mind that none of them have a clue as to how to eat properly, but I'll bet very few of you folks do, either. Many health care professionals are overweight, because most people are.

But those of you who can afford fresh fruits and vegetables, these people probably can't.

If you were going to put together a pamphlet written at the fifth or sixth grade level (which is probably about where these folks function) what would it say?

It's easy to sneer at them, but that won't really, as a practical matter, change anything.

No, you're not. I have two children in grade school. These folks probably didn't go to the best schools, and bear in mind that the cafeterias in most grade schools sell the very worst junk. They have cake and cookies, chocolate and junk handed out on a routine basis, and there are vending machines in the high schools selling sodas and candy.

The foods for sale in the average elementary school cafeteria are an outrage.

My younger son's private school has a healthful food policy, but not too many of these folks can afford private school.

Since the average educated adult doesn't grasp that the average muffin has 650 calories, why should we expect these folks to know more?

Actually, you are. I went to a run down shitty school and learned a hell of a lot. My nieces and nephews go to a semi-decent school and learn alot. In high school you're required to take a health class, where you learn about nutrition. You're taught that sugar is bad, fruits and veggies are good. There are commercials on all major cartoon channels telling you what's good and what's not. Telling you to go outside and play.

Believe it or not people know what's good and what's not. They just don't bother to do what they were taught. Twinkies and sugar taste good, carrots and celerey aren't as good.

Sure they have cookies and cakes in the cafeteria. 1 serving of that stuff isn't going to make you HUGE. They have vending machines. Costs a dollar or more to get stuff out of them. That's expensive, if you're on government support you shouldn't be doing that. Eat the free meal in the cafeteria and be happy that you have a full stomach.

Actually the people who assume the worst about the fat folks in the pix come off as quite "psychic."

Since there is an "obesity epidemic" in this country, clearly the intellectual elite don't know how to eat any more than Gargantua and Pantagruel over there.

You can buy cheap meat. A gallon of milk is $4.00. But a few days's worth of produce is more than that. And remember you can't buy produce in bulk because it spoils after a few days, so you also have to figure in gas money.

In some of these neighborhoods what you have by way of food stores is the 7 11. These people can't afford to drive to a grocery store because those places are too far away. They go to the neighborhood conveniece store, where the freshest meat is the beef jerky sticks.

I know everyone here would be happier dehumanizing these people, but if you walk into the average hospital there are so many obese health care professionals it seems ridiculous to pile on these two folks.

Yup, I lived off of less than minimum wage for a long time. I did fine. I was never overweight. I went hungry a night or two, so I could feed the sis, but that was alright with me. I vowed to get out of it. I did.

Being overweight isn't the issue. Being plump, or even fat isn't the issue. Weighing in at over 200+ for a female or over 230+ for a male is just wrong.

They don't have a car, so gas isn't an issue either. Public transit. A bus ticket doesn't cost that much. Don't have public transit? Walk.

People know that being overweight is bad for you. They don't care though.

thanks for getting me to look at them through the prism of a leftist...

great points. i didn't really realize that these tub-Os were HISPANIS FOR FUCKS SAKE. everybody knows THEY are hopless.

but FAT HISPANICS, whew! no fucking way they will even be able to put one foot in front of the other without us smart people taking other people's money to give a bit to them. sure feels good, doesn't it?

then as an added bonus they will vote for us because we have told them how the conservatives don't care about them. how could they, they won't give them any more money and they expect them to work!

end sarcasm. thank you, whatnow, for demonstrating without meaning to, the core beliefs of the lefties for us. we are superior, they are inferior, they can't do it without us, therefore we need to make sure they get some money. rather than give it to them ourselves, let's take it from 'rich people who don't deserve it'... let's pass a tax law... that will be my gift to them. i'm so smart. they are so stupid. aren't they lucky to have me! (what, they want to shake my hand.... heavens no... gotta run pic up khaki at the groomers...

serving four years in the military blew this little bit of wisdon clean out of the water with a high percentage of these 'hopeless' cases going on to get college degrees or to careers in the military where they learned how to take apart and rebuild fighter jet engines. the only thing wrong with the two unfortunate ladies above is that people keep handing them money and they have never had to get a job.

and speaking of that minimum wage job that 'pays nothing'. all of us here have worked minimum wage jobs. it's where we started. the point is... we started, and we believed we could do better.

the only folks to blame for the plight of these probably very nice ladies is the entitlement crowd and the ladies themselves.

if they are smart enough to fill out the forms they fill out to get free money they are smart enough to do a job. they might also learn a bit about responsibility, but you really don't want them moving up and out of their near poverty lifestyle (which, in most other countries, would be seen as 'middle class').

in fact, when i first read this, it reminded me of the pro slavery argument that was floated before the civil war... blacks are too stupid to live in a free society etc... welcome to the modern democrat party.

since, however, i have been smart with my money and attended medical school i have a lot of money in retirement, savings, and stocks, so i would not 'have to'.

if either of these nice ladies had been told that they needed to work, and they stuck to it, they would easily be making twice or three times minimum wage now. but they never tried. they never tried becasue of people like you who enabled their laziness and their getting comfortable with days filled with idle television watching and cheeto munching. i feel really bad that they can't afford ice cream anymore though, now THAT is tough.

i take care of folks like this in the ER every day. they have no plans for the future, no idea about holding down a job, none of it. they don't have to. they are quite comfortable and have no stress (with the exception of having to 86 the ice cream until obama gives them $50 more per month of my money.

I agree with many of these comments. What is frightening to me is this learned helplessness is handed down from parent to child like a family tradition.

But more importantly, I want to know where ee finds bread at 79 cents a loaf. In my neighborhood supermarkets I am happy to find a loaf of whole grain bread for under $3.00! (Trader Joe's has the lowest everyday pricing for whole wheat bread, imho.)

Yes, I too am a thrifty shopper. Pasta, tuna, yogurt, fresh fruit and vegetables, generic store brands--it is possible to have a healthy diet on a budget, but as someone mentioned above, it takes effort.

and anonymous, if you bothered to read the post and the story you will see that no where are these ladies put up for ridicule. the ridicule is directed at NPR for picking two hugely overfed women in their story as an example of the hardships of ohioans on the dole. NEVER, until you guys started doing it, did anyone, including DRX, direct any derision against the ladies in the picture, only at NPR for being so indoctrinated that they could see these folks and talk about hardship.

In the United States, the majority of food items have caloric content and nutrition information printed on the package. Opening the mouth and shoveling in the food is a conscious decision. No one is forced to eat 4000 calories a day. Those two need a dose of self control.

Frozen vegetables are not expensive. Peanut butter is not expensive. Wheat pasta is not expensive. Reducing portion size is definitely not expensive.

honestly, thank you. you are obviously on your way to a bright future in whatever field you choose to pursue as you choose to work and go to school (and struggle while you do).

if we run out of folks like you then there will be equal misery for all, but no way out.

it matters not to me at this point. i've worked 13 years in medicine and have been smart with money so me and mine will be fine whatever happens... my passion, and many will disbelieve this, is for the two gals here (and all in similar circumstances) to learn that their horizons are limited only by their external locus of control. it's still america i think.

From your formerly broke-ass ER nurse, I can inform you that Aldi sells loaves of bread for 40-75 cents and the grocery store near my house that is usually expensive sells day-old bread at approximately $1 per loaf. New wheat bread is about $1.65/loaf for the "store brand".

For $1000/month, it's hard to find your own apt to rent and have $ leftover (you could probably get your own studio here for $500), which is why you need to live w/a roommate or with family. Living in your own place is a luxury that can be modified.

Okay...first of all, where I live, bread is $4.00 a loaf. Second, these clearly are not the brightest folks around and higher education is not in their future. $450 for a family of four for food is more like what people will spend even if they eat Kraft Mac N Cheese, spaghetti and peanut butter. And if these people are at work, someone has to take care of their children. Where I lived child care for two children was $1000 a month, and that was not at some posh private cushy place, but at one of those franchises. So you can spend your entire paycheck on childcare.

Milk where I live is $4.00 a gallon, bread is $4.00 a loaf, and not the expensive crap, either. The electric bill around here averages $180 in the summertime.

These people are never going to do better than minimum wage. A one-bedroom apartment in my locality is $500 a month in a crappy area, and surely these peoples' parents aren't living in a 2500 square foot house if their offspring are uneducated minimum-wage-earners.

Nutrition education in the schools is pathetic. And it's ridiculous when the teacher might go on ad nauseam about the food pyramid for precisely an hour, then march the class down for lunch, when the school has a contract with Taco Bell and the vending machines in the school cafeteria sell sodas. Let's not forget that it's someone's birthday every other week and so there's cake, cookies and cupcakes in the middle of the day. So what these people -- who can educationally absorb very little -- hear is one hour of food pyramid and then what they see and eat in the average schoolhouse is another matter entirely.

The only thing worse than school food in this regard is hospital food.

Most Americans, educated or not, don't understand food, and have bizarre magical thinking about food. They think that if something has high nutritional value it can't make you fat. They think that a salad must not be able to make you fat, even if a chef's salad is 750 calories. That's the average American on the street, which is why so many Americans are fat.

I'm sorry, about half the nursing staff in the average hospital is markedly overweight. So how do we hold these pathetic people to a higher standard?

If you sat these people down and quizzed them about diet, they'd be ignorant. And how can we expect them to understand portion sizes when the average restaurant doesn't?

So the legitimate question is, they're in your office. You could speak to them. You could tell them something. What would you tell them? How are they supposed to work at a minimum wage job or two and then support their children and pay their medical bills?

Yes, most of us have advanced degrees. Most of us are slim. Our children are slim. We take our medication as directed and we even know what we take and why. But even among the educational elite you hear remarkably stupid things about food and eating.

Even supposedly intelligent people will say, "We only use 20% of our brains."

ERDoc911's solution to someone asking questions is to call a stranger on the internet a douche. We revel in his inherent superiority to the rest of us that he himself earns enough money to guarantee that he never finds himself in this position. Great. A moment of reverent silence. He's very fortunate that he is not a solo practitioner who finds himself with a case of dilated cardiomyopathy and is suddenly unable to work. Does that person end up on food stamps? Not right away, no. But if he doesn't have disability insurance because he can't pay for it, and his parents are dead and his children are college students, what do you expect from him?

The fact is that there is a whole subset of the population anywhere that is like these people pictured here. They aren't that intelligent. They don't have a lot of skills. They don't have a lot of impulse control. They don't plan ahead much. They're never going to make it much beyond subsistence. Why? Go back to the main point: They aren't that intelligent. They have it better in the US than in any time in history, but that doesn't change the fact that they are who and what they are.

The question I had is, what do you propose to tell them? What do you propose for a solution? Since these people are never going to go to medical school so they can be as perfect as ER911, what now?

You really need to plan a trip to Southern Texas. The "illegals" who work in construction with "minimal intelligence" drive 2008 Ford and Chevy crew cab trucks and run construction crews. Their wives run the taco trucks and/or sell tamales on the side. They make more money than I and my husband do with advanced degrees.

"They aren't that intelligent. They don't have a lot of skills. They don't have a lot of impulse control. They don't plan ahead much. They're never going to make it much beyond subsistence. Why? Go back to the main point: They aren't that intelligent. They have it better in the US than in any time in history, but that doesn't change the fact that they are who and what they are.

The question I had is, what do you propose to tell them?"

I propose to tell them that they have no right to the money I've earned.

Just because I'm intelligent, have impulse control, and am able to make some money doesn't mean someone without these qualities has a right to my funds.

Anon--bread wouldn't be $4 per loaf if you made it yourself. Sometimes you have to do something other than what is convenient to provide for yourself. Yeah, you may have to wake up an hour earlier to take the bus to work than if you had a car, but OH WELL. You may need to spend extra hours finding someone who is willing to provide daycare at a price you can afford (eg. neighbor, friend, relative). PS Franchise daycares are very expensive relative to licensed in-home daycare. I just priced this stuff out for summer daycare, and the franchises were almost double the cost of church-based care and in-home care.

You've got to be one of the most arrogant sterotyping people who have ever posted on this blog. Your latent hatred for fat people is just oozing from your comments. Americans are fat because we can be. We don't have to work that hard for our food, it's cheap and plentiful. We understand the food pyramid and caloric intake is no big mystery. We just choose to indulge. Because we can. The same with the people in the picture.

Well, we just had a hurricane down here...and the stupidest thing I heard a tv newsperson say (as they showed some very hefty people lined up for the free food)..."these people have gone literally HOURS without eatting....HOURS???? Isn't that like from lunch to dinner. Granted we all wanted a hot meal since the electricity was off, but I feel more inclined to donate to somebody who has missed a meal or two...not just a measly hour or two of not stuffing their faces.

it must be a hell of a thing to be exposed as being, not only a douche, which you are (check the dictionary next to your picture), but an elitist, condescending, muddle-headed, racist who has been educated far beyond their intelligence...

"These people are never going to do better than minimum wage...If you sat these people down and quizzed them about diet, they'd be ignorant... And how can we expect them to understand portion sizes when the average restaurant doesn't? The fact is that there is a whole subset of the population anywhere that is like these people pictured here... They aren't that intelligent... They don't have a lot of skills... They don't have a lot of impulse control... They don't plan ahead much... They're never going to make it much beyond subsistence... Why? Go back to the main point: They aren't that intelligent...,

let's say you are right, which you are not because you have proven here that you 'are not that intelligent', how is it then that the answer is to pull more money from taxpayers SO THAT THEY CAN CONTINUE TO SPEND IT ON ICE CREAM.

what we do is to tell them that they CAN, in fact, do better, and that they are the ones who need to do it and that the way to start is to start working for what's theirs. their benefits SHOULD only provide a bare bones existence... it SHOULD be hard.

getting a job and working SHOULD pay about the same as getting shit for free, but it would soon provide more, much more. i'm glad that it's tough for them becuase that's the only way they will cease to be dependent on elitist fucks like you, anonymous.

right now, they vote for you and you don't want them to move on up because you would have less power and be exposed for the fraud you are.

it's quite simple. we put responsibility for their well-being on, well, them. they are not retarded like you think they are, merely dependent. fucking hard to understand i know, but it works everwhere it's tried. basis of our great country you know...

the only thing that puzzles me is that somehow folks with your view of this issue are somehonw seen as being compassionate and caring.

you talk about these two ladies like ther are vermin, you talk about them like they are stupid, but i see them every day in the ER and they are most certainly none of these things. they have merely chosen the path of least resistance because folks like you have encouraged them to do so, told them 'it's the best you can do", and then pointed the finger at folks like me as the ones that are hateful for not buying them ice cream.

you are a douchebag, anonymous. you are arrogant, and you are not nearly as smart as you think you are. if i were you i would slink away and go somewhere where your bullshit will not be put out in broad daylight and exposed for the nonsensical hatred that it is.

my money is where my mouth is, again, i take care of these two, for free, every day in various shapes and sizes, and i'm rarely mad at them, i'm mad at you, anonymous, for tricking them into dependency and hopelessness and low expectation thinking.

there, that's me, a conservative, pointing out that it's you, a liberal, who is, in fact, the one who is full of hatred and racism for the underclasses.

First of all, I am non-plussed. Where do you get "racist"? Who said anything about race? I surely didn't.

Also, who are you talking to, Doc? I'm not a politician, and actually, I'm not a liberal. I'm just a realist. Everywhere, throughout history, there is a class of people just like this. I suppose we could go back to Victorian England and throw them in debtor's prison -- maybe a lot of folks posting on here would feel happy about that as a solution. Somehow I don't see it.

Reading health care practitioner blogs it is one long rant against this very class of people. As far as I can tell there is very little practical advice as far as what to tell them.

I asked a simple question and I got a response that makes it clear that you have real self-control issues. What do you tell these people and what do you do with them?

You can't even get these people to comply with their medication regimens -- you can't even get educated people to do that -- as a study showed that when they put a computer chip into asthma nebulizers the medication compliance rate was something like 36% -- and you can't get educated people to lose weight. But you are going to somehow get these people to pull themselves up by their bootstraps?

Oh, wait, many of the posters in the comments section can't even be bothered to care what happens to them: "Just tell them they can't have any of my funds."

Lots of disingenuous commentary about baking your own bread when a minimum wage job can't sustain a family of four anywhere. Not if you're putting the children in child care. In my locality, child care for one school-aged child before and after school is $300 a month. That's through the public schools, and that only gets you until 6:30 p.m. McDonald's is open all night in some locations.

1. Every liberal I know says that 'dumb people' simply make bad decisions and need lots of our money to make their lives comfortable. Screw that. As 911 said, in every society there are haves and have-nots. Liberals want the have-nots to have pretty much everything they want to make life EXTREMELY comfey...and hell yes, it's gonna' come out of the pockets of the wealthy. Well kiss my ass. At some point, the wealthy say enough is enough. People on the take don't need fucking Iphones, DirecTV, and Nintendo Wii. FUCK THAT! A roof, some heat and water, and some food. A bit more to get to and from the jobs they don't want to go get. That's it. GO MAKE IT HAPPEN PEOPLE!!! Many before you have!

2. I am going to bitch-slap the next liberal who says I am wealthy and successful because "You're smart. That's it. You're smart and they are not." How fucking insulting is that? I grew up middle-class, chose to borrow LOTS of money to make something of myself by putting myself through college and medical school. 10 years later almost have them paid off. I have countless friends from my middle-class midwestern hometown who were just as smart as I am who have FUCKED UP lives...drug overdoses, selfish and just plain BAD decision-making. They are responsible for THEIR decisions just as I am. I am already giving 1/3 of salary to the government. You want more compassion? NO. WE WANT MORE PERSONAL RESPONSIBILITY. Some people cannot take care of themselves - severely mentally-ill, physically handicapped, etc. The rest? Work it the fuck out. Go find jobs, work hard, make a living. The hispanic immigrants seem to do it...because they work their ASSES off and want to create a better life for themselvs and their families. the lazy dumbasses can live a life that is NOT comfortable as 911 says...it ain't supposed to be comfortable.

You want compassion for the two ladies in the NPR story and their ilk? We provide compassion for them EVERY day by giving them most of what they want and need for FREE. What more would you like them to have? They get free housing, food, and health care. They also need??????

When Ann Coulter (my dream love goddess) says that liberals HATE America, she is right. YOU, anonymous, hate your country because you want to continue to take money from hard-working capitalists (by whom this great nation was built) and give more to the 'dumb people who can't help themselves'. Brilliant.

I guess you went to one of the Ivies, or Stanford, or Berkeley, or UCLA or something like that.

only that kind of pompous arrogance explains you writing off the vast majority of the EM blogging community, EM nurse blogging community, and EMS blogging community, all of whom exhibit a large degree of anger, as having “self control issues’’.

i trained in a major inner city trauma center; i have worked in three very busy ERs since residency that serve 70% uninsured. i have done so for over twelve years. my clientele IS these two ladies, and they, as you rightly say, do not have a lot of education.

i do not, however, believe that they are beyond hope as you do. i actually think they CAN do a lot for themselves BUT people like you, and the liberal politicians, tell them they can’t so they believe it. after all, you guys are the smart ones right?

my ‘self control issues’ are certainly there. Every day i restrain myself from taking my local form of YOU outside for a sound ass-whuppin’ because YOU are the source of the shitstorm that has become emergency medicine and, worse, the growth of the nanny state in the LAST PLACE IN THE WORLD it should be.

if you are a physician then do a few shifts in your local trauma center. See the 60% of patients calling EMS because it’s cheaper than a cab. see the medics who make barely more than they would on disability getting more and more angry at these freeloaders and continue to do excellent work for them. see the number of patients with horrible diseases that keep coming to the ER because ‘it’s free’… you did this to them and you did it to me. You and all your liberal friends.

grow a fucking penis for the sake of all that is holy. if you are not a liberal then what the hell are you? pussy.

finally, how much is enough? i mean, i give away $150,000 in ‘free care’ a year, and then pay upwards of $50,000 in taxes. how much is enough? come on pussy, tell me.

tell me what the number is, give me a ‘one time’ number, and then cut me loose. I would take out a second mortgage, and put my nose to the grindstone for two years to pay it all off now. It would be much cheaper than what’s coming.

the result is that i am leaving. so is ‘cat. so are others. and guess what, if you don’t do EM every day, then you can’t do it.

You can’t get that critical intubation with posterior oropharygeal bleeding, you can’t run the code, and you can’t save lives when it counts.

no, the clinical part of EM is not particularly difficult, but the skills of EM care ARE. i got called to our ICU the other day to intubate a patient for the critical care doctor… he was standing at the bedside and out of his depth. a critical care doctor.

in about five years enough people will have died for idiots like you to finally say, wow, we sure do have a crisis in emergency care, maybe we should listen to these guys. good for you. i hope to never come back…

i’ve done my time in the trenches taking care of ‘’hopeless cases’’ like this, many of whom are actually smart enough to listen to what i tell them about their ____-care insurance and the fact that if they wait for the government to take care of them that they will be waiting a long time… maybe until they die.

now be a good sort and go troll somewhere else and make someone else’s day miserable.

Doc, I worked in public service for well over ten years among the very same people that you describe. I donated a great deal of my time as well.

Yes, I have seen what happens in the average ER. The people I served often turned up there.

None of you have talked about the most obvious problem that drives just about all of this: You can't work a minimum wage job and make ends meet. There is absolutely no percentage in it for these people to work as long as the child care costs cancel out their wages immediately, and where they can't afford to pay their rent. I'm not just talking about the folks on public assistance, I am talking about the likes of the folks who turn up on Judge Judy, as well.

These businesses intentionally prohibit the average worker from getting forty hours a week so they don't have to pay for health insurance, and some places have policies that part-time workers who work more than nine months out of the year get benefits, and they begin to force those workers out too right when they begin to qualify.

I'm suggesting that these problems will be with us as long as this state of affairs continues.

I'm suggesting that you people would be a hell of a lot more credible if someone could go get a job at McDonald's, work a forty-hour week, be able to rent a decent apartment, and feed a family of four. Oh, and even get well-child checks for their kids and pay for their medication without losing their shirts.

As far as the nonsense that goes on in your ER, I am well aware of this -- having witnessed first-hand the guy who called 911 because a dog bit him right [look with microscope at invisible injury on arm, fail to see injury] there. That guy? He's a social service problem, he's got mental issues and yeah, he really shouldn't be pulling the ambulance away because there will be a shooting in another ten minutes right in that very area given the statistics. And yeah, there was also the kid having an asthma attack because they don't give the kid his Pulmicort every day, but the ambulance couldn't get to him because of all the shooting.

I am suggesting that for some of these people -- not all -- community outreach might help these people distinguish between an urgent problem (urinary tract infection, ear infection, anything else non-life-threatening that nevertheless really hurts a LOT) and an emergent problem. But that guy with the dog bite is a mental health case and what the heck you do with him, I don't know. It's nearly impossible for anyone to get decent mental health services. Children with Down Syndrome were getting turned away from special education services in my district, though, so why should I be surprised?

But then these people have to be given a place to go when they have urgent problems. As a matter of fact, that would be true of the college-educated guy with the sprained wrist and the well-educated mother whose kid needs IV fluids, too.

Some of these people will never learn. It's ingrained in the culture. But I just don't feel particularly inclined to sneer until it's possible for someone like that to go out, get a job, and actually live on what they make.

You people almost restore my faith on humanity..My fellow authors on our blog, Amy, Nurse K, Dev(where's RubyRidge?) I am proud to be able to write occasionally for people like you to give you a little light time in our Universe.

I do not like to see how upset you become at these Anon POS's. You already have to deal with the consequences of their politics on a daily basis, but Lord, it produces some remakable insight and commentary. I wish I was smart enough to retort the way some of you do..I'd rather "take a flame thrower to the place" ..

I work a minimum wage job, pay for all my necessities, and for school at the same time.

If you know you can't take care of your own child, give it away. I couldn't take care of a child right now with my income. Any rational person would either terminate the pregnancy or give the child away to a family that can afford to feed it.

Irrational people who keep children they can't afford don't deserve handouts at the expense of the rational.

If a 10 year old hits his kid sister, mom should whoop his behind, not give him ten bucks from his sisters piggybank.

Anyone referring to a child as an "it" probably needs to grow up another ten or twenty years.

What miracle place do YOU live in where someone can live on $1000 a month and pay college tuition?

What you're saying is that someone only capable of earning minimum wage should never have children. That's disgusting.

Amazingly, you don't even seem to distinguish between people who started out on minimum wage and, say, women leaving their husbands who are just trying to land on their feet, people whose businesses have failed, people whose health has taken a horrible turn for the worse (breast cancer with no health insurance?), or people who have temporarily fallen on hard times.

Meanwhile, you twenty-year-old childless twit, when you give a kid (it??) up, where do you think "it" goes? Into the foster care system. Who supports the foster care system? The state. What kind of services do you think a kid ends up needing if a parent "gives it up" because of temporary hard times, or assuming that this person has a high school diploma, no skills and one or two children and decides to do what you suggest (what a barbaric suggestion). Yeah, no problems resulting from immediate separation from the only family the kid's ever known! And foster homes are just such wonderful places!

None of you people have had the guts to address the fundamental problem -- that any of these people who wanted to do the right thing and get a job that they were qualified for couldn't make ends meet on a bet.

It does not take a Mensa member to know that education is important, (at least start with community college and go from there if you can't afford anything else), guidelines on healthy nutrition are plastered everywhere and as someone above mentioned, portion control will work wonders on your weight AND wallet. Bottom line: those two ladies made bad choices, still do and now have to live with the consequences. It is not right that somehow, this becomes my problem.

"Meanwhile, you twenty-year-old childless twit, when you give a kid (it??)"

An ad hominem attack is not a valid argument.

"What you're saying is that someone only capable of earning minimum wage should never have children. That's disgusting."

I'm saying that it's unfair for the children to suffer because the parents have made bad decisions. If one can barely subsist on minimum wage as a single adult like you say, why would you ever have a child? It's morally incorrect to starve a young child or neglect it for hours a day. That's child abuse and should be punished as such by the courts. If you can give your kids what they need while making minimum wage, more power to you.

Dr. Olasky of the University of Texas writes that "the dramatic progress of Asians and Cubans in recent decades demonstrates the existence of opportunities for those who are willing to conform to the traditional work-hard-and-rise pattern by staying out of the welfare system". People can rise through the system and make ends meet. They just have to take the opportunity.

"Meanwhile, you twenty-year-old childless twit, when you give a kid (it??) up, where do you think "it" goes? Into the foster care system."

I call bullshit on you anon. We both know that babies are snapped up as quickly as they are available. It's so hard to find a baby in this country that people have to go to other countries to adopt their babies.

Allo, dappy English k-niggets and Monsieur Arthur King, who has the brain of a duck, you know. So, we French fellows outwit you a second time! How you English say, 'I one more time, mac, unclog my nose in your direction', sons of a window-dresser! So, you think you could out-clever us French folk with your silly knees-bent running about advancing behavior?! I wave my private parts at your aunties, you cheesy lot of second hand electric donkey-bottom biters. No chance, English bed-wetting types. I burst my pimples at you and call your door-opening request a silly thing, you tiny-brained wipers of other people's bottoms! Yes, depart a lot at this time and cut the approaching any more, or we fire arrows at the tops of your heads and make castanets out of your testicles already! Ha ha haaa ha! And now, remain gone, illegitimate-faced bugger-folk! And, if you think you got a nasty taunting this time, you ain't heard nothing yet, dappy English k-nnniggets! Thpppt! Dappy!...

Goodness I love this convo. You say that "None of you have talked about the most obvious problem that drives just about all of this: You can't work a minimum wage job and make ends meet." Hey, I agree!... for the most part. The issue here is about WORKING and taking some sort of personal responsiblity for you and your family's well-being. To quote the article it said that "most of her (sic) siblings and spouses are unemployed". You know what? They're not even TRYING! Gotta love that. Oh but wait, I forgot, she's disabled. The accident left her so depressed and all. I suppose that the rest of her family suffered some sort of sympathetic PTSD as well from the tragedy.

Unfortunately, one of my close relatives has the same body habitus and is "disabled" (from her morbid obesity). She gets a disability check for this and promptly spends it on high-speed internet, extended cable, and gets her dog groomed twice a week with that money. How does she make ends meet, you say? She leeches off my grandmother's social security check while my grandmother condones this parasitic behavior. The electricity has been turned off several times in the house because, as this big-boned gal once told me, "Well, that's not MY bill". Nice. Keep on eatin', sistah. She's not stupid, she's just working the system. This is the kind of entitled attitude that we are working to pay for.

Oh, I too am the product of a lower middle-class school that received government assistance. I grew up in an area of town called "Five points". Not too many areas of the country where "Five points" is the ritzy section. However, despite being turned down for the "PASS" class (for gifted children), I still managed to learn self-discipline and personal responsibility . Living proof that you don't have to be a genius to figure basic premises in life.

I suspected that, with the Monsieur Arthur ref. Shame on me, I have never seen Holy Grail but I loved The life of Brian, though.

(Ironicaly, I am up for another 1 hr 1/2 to call a French vendor when they open shop but since you seem to speak French (ah!),I'll give you the info and you can call for me, since you are up anyway. The double espresso from the Bialetti is not helping much).

I have to find something to keep me busy and awake, maybe I'll get some crosswords...

Quixxote,

"The accident left her so depressed and all. I suppose that the rest of her family suffered some sort of sympathetic PTSD as well from the tragedy."

This is funny but a really logical conclusion!Last night at the grocery store, I saw an entire family of very large people: Mom, Dad and son in a car with a disable tag.Mom and Dad made a bee line for the motorized/scooterized carts and took one each. It is a never ending circle: they can't move well, so they don't and their pains and aches increase for lack of activity. So they file for disability.

Ben working but I love the thread. This is a free, upwardly mobile country last time I checked. Anyone can start from nothing and become everything. I have worked for everything I have (family of 9 raised on a teacher's salary). So fuck off all you bleeding hearts. A crystal ball and time machine would serve everyone well, but due to the gimme mine now and where's my check mentality most people have been told by the bleeding heart left to stay right where they are and continue to vote for them and their check will get bigger. Wake up dumb asses. Look at almost every large city in the U.S. run by liberal dems. A great big piece of shit. I say grab your boot straps, stop letting people tell you what your lot is in life, put down the crack and the meth, and get a job. I started at McDonalds too you fuckheads.

Duh. They are not supposed to. These are the kinds of jobs you have during the summer when you are 14 years old. By the time you are 25 you are supposed to have applied yourself and moved up on the pay scale

Yeah, that would be the hope. But if you have an IQ of 85 or 90 like half these folks, that's all that's open to you.

If you have a high school diploma and are intellectually incapable of getting a college diploma, what the heck are you supposed to do?

I know that the world is full of uneducated entitled jerks, but the world is also full of people who can't do college work, and aren't capable of learning a skill.

Exterminating these people is just so passe, since Hitler tried that route and it just completely revolted the civilized world -- as well it should. We don't have a T4 program here in the United States because it even revolted the Nazis.

So, I maintain, until you can do minimum wage work and support your family, you really have no right to spit on people who aren't educated but can't support themselves. If you could make a living wage working at McDonald's, Best Buy, Border Books, etc. (retail) then I would have a lot more sympathy for those folks who like to crap on the people pictured in the main post.

You are 100% right, and YOU CAn live on Min wage. Not well but you can.

Plus if these two ladies were truely worried there are churches too that can help them with food, education and they can APPLY for govt training.

My state on the SS/Medicade/ program was finding and GIVING away jobs! They did a report, 1/2 the jobs started at $12-13 dollars a hour. One example was a insurance office. The state payed for childcare in order for her to work, she quit a month later. Not for her loss of SS check( she was still getting that and her salery) but because"It was too much to raise her kids and WORK!" These people are getting better jobs then I can off the street.

I put myself through school on 3.25 a HOUR. Plus more then once in my life I have held 2 jobs and so had my husband in order to PAY BILLS. Did we like it"Hell no" but we did it.

We have come close a few times to loosing our home, he has been deployed several times also, but we did it. Hell we even got bus passes at times too to get from point a-b, even if the ride was a HOUR. There are ways.

To the leftest loon anon, you are sadly mistaken, if these two fatasses really wanted to make it in life w/o a handout they could. HOW come all the FUCKING family is on SS? I mean give it a rest. Too depressed over a CAR ACCIDENT, heaven help us all. I was in 2 and man...I should have thought of that, , I will have to tell folks this line of Bull Crap.

I was raised"Do what you have too" Do I have a degree, no. I am just a sad lil Medic in EMS land, who at places makes just over min wage. I am in fact paying my own way to RN school. Does it hurt? Hell yes, but we have given up alot in the last few years in order to be better. I suggest these folks should too and get off their ass, stop the pity party, and however they can go to work. Leave my taxes in my paycheck, "I" earned them they did not.

Victoria said:Just because I'm intelligent, have impulse control, and am able to make some money doesn't mean someone without these qualities has a right to my funds. You, gurlfren', are my new best friend.

911 sez:they have merely chosen the path of least resistance because folks like you have encouraged them to do so, told them 'it's the best you can do", and then pointed the finger at folks like me as the ones that are hateful for not buying them ice cream. Let's all spell it togther, kiddies: l-i-b-e-r-a-l-s. The idea is to keep the little guys feeding from the public trough so they'll be beholden and dependent. Tell someone long enough that they're unable to take care of themselves without public dole, and they become their own fulfilling prophecy. How else can you control an entire population? We producers are a much-maligned group by the libs because we see through this crap. Unfortunately they need us because they need our check books.

Anon, you need to stick your nose in Ayn Rand's Atlas Shrugged. This is where we're headed thanks to people like you.

If you want to "help" these people by continuing to enable them do it yourself. No one is stopping you. Knock yourself out. Give them your whole paycheck. Make them a wholesome meal and serve it to them in bed. Or better yet give them your bedroom.

DON'T FREAKING DO IT WITH MY MONEY THAT I WORKED HARD FOR, DO IT WITH YOUR OWN MONEY AND TIME.

Anon,I the folks over at "assault weapon watch", the only lib site linked on my blog, could use your passion. in the meatime you might google 'tin foil hat' and follow the easy 'do it yourself schematic.

You should be able to work at a minimum wage job and support a family of four.

AnneCoulterLover: Where in that statement is any suggestion that they deserve a handout?

I am suggesting only that right now it is impossible to make a living on minimum wage -- especially if you have children -- and so as a matter of policy you're going to have people avoiding working.

None of you people, apparently, have reading comprehensions much higher than the people you malign, and stop pretending you have compassion for these people, given that none of you batted an eye at the flour joke. You have no trouble at all with people who objectify these women in the most degrading way possible, but the teensy beensy suggestion that if they got a job, they might be able to live on what they makes has reputedly mature people having little Napoleonic temper tantrums.

Talk about learned helplessness. I asked a simple question: You are a health care provider. You have these two women in your office. Recognizing their manifest intellectual and educational limitations, what do you tell them?

I pointed out that even schools can't by example serve as sources of information about healthful eating for the reasons I mentioned, and also pointed out that the average well-educated individual can't either. In fact, I observe that EMS personnel and nursing staff (and quite a few of the anesthesiologists and pediatricians out there) at the average hospital and medical building themselves have weight problems.

In fact, twenty percent of people in the US qualify as not merely overweight, but obese. So many, many people haven't figured out how to eat properly.

Here's a start: Aspartame increases appetite. It is an appetite stimulant after the first 12 or 24 hours (I forget which).

These people make up any reason they can to not work, but given the fact that you can work a job that either of these two women can work and not make a living, I am merely suggesting that a change in policy is in order.

No where, but no where, have I suggested that these people are entitled to a handout. What I have been saying is something people can't honestly answer, in good faith.

I have to say too that I haven't seen a more shrill contingent of profane, obscene thinkers outside of a graffiti-covered bathroom wall. None of you can debate in good faith. None of you address the actual premise -- that it should be possible for anyone of any ability to go out and get a full-time job and be able to support a family of four. No where did I even suggest that people are entitled to have as many children as they want if they can't afford to.

Other than point out -- protesting too much, I think -- the many ways in which you are different from these ladies, making obscene comments, and calling names, none of you have addressed the one consistent premise I have put forth: that there has been a class of people like these two ladies in every culture in history; the Victorians dealt with them by allowing them to starve, putting them in debtor's prison, and consigning them to beggary. But then, they also had little children working 14-hour days doing piece work.

You people don't seem to want to kick around potential solutions. You just want to make flour jokes, talk about how you're superior to them, ridicule them and scream at straw men.

Socialism didn't work, but neither did allowing these people to starve to death. I pointed out a solution that might work -- which is that if they did work, they might actually be able to earn a living -- which is a solution that hasn't been tried before. But none of you apparently can read well enough to see that and answer it intelligently. Instead, you'd rather complain about them.

I've got it! Let's raise the minimum wage! Wait! Let's look around and see who has too much stuff. Then we can get the government to take the excess and give to those in need. At the same time we can install solar panels and windmills everywhere and crush all cars getting less than 50mpg. I get it now... It's so simple! The folks currently living on minimum wage are liars. Next we abolish war and mean people! Anon, will you do this for us? You're almost too smart for us to understand. Thank you for your patience .

I knew you couldn't do it. You couldn't actually addressed the points I raised. You had to construct a straw man, because that's the only way you can hold it together.

If someone disagrees with you you go on an apoplectic rant. You can't engage in reasoned debate. You bring in all kinds of ridiculous ideas that are nowhere mentioned anywhere in anything I said, because you can't address what I said in a reasoned way. You have to manufacture things that are completely unconnected with the main points raised. I suppose chronic sleep deprivation might do that to the reasoning skills. The truth is, you're a bully. Believe it or not, it's not interesting to me whether you were a bully before you decided to work in the Emergency Department, or became one after you got there.

Where I come from, after working for a long period of time with shaken babies, scalded children, beheaded teenagers and other completely unavoidable carnage, people switch departments for a while because long-term exposure to this sort of thing tends to dehumanize and desensitize people to the suffering and weakness of others. Time to switch to plastic surgery for a few years until you get your emotional equilibrium back, doc.

You're a physician, but you can't come up with one useful thought about meaningful social policy. That's not surprising, given the fact that you spent your entire undergraduate career taking chemistry courses and physics. That doesn't make you an expert on social policy -- although you seem to think you are, but as soon as anyone has a question, you start talking about windmills. How long have you associated a living wage with windmills and Priuses, doc?

I don't know who you're angry at -- although it appears to be just about everyone -- but nothing you've ranted about is connected in any logical way with any of the objections I've raised.

Nothing you're doing in your ER seems to be changing the way things are going there. It couldn't be that seeing this particular class of people realistically and proposing a solution that takes their limited resources into account might actually effectuate change.

You're not capable of having a reasoned discussion. I'd suggest getting some sleep but your problems seem to be a little deeper than that.

Where I come from they'd consider someone with your responses severely burned out and in need of a long period of R & R. Especially in someone with regular contacts with the public.

Oh, and I should clarify. I referred to shaken babies, beheaded teenagers (and other casualties of unseatbelted, drunken driving) as "unavoidable carnage" because of the perception of the clinician that it doesn't seem to stop.

I am not suggesting that someone who shakes a baby, scalds a baby, or drives drunk should escape the consequences of their behavior.

I do believe there is a class of person who is incapable of responding in an intelligent way to children. But given the way I have seen nurses screaming in a rage at older adults coming out of major surgery, I'd suggest that I wouldn't trust some health care professionals alone with a small child any more than I'd trust them with the asshole who thinks that dipping a toddler in scalding water is the appropriate punishment for wetting her pants.

Anonymous: If we throw a ball, will you go away? This blog was founded by 911, so he can say anything he wants. I don't agree that he is unable to employ reason (and gosh, he is smart enough to figure out how to construct a fake name and avatar). In fact, 911 went to two years of law school. And DUH, he is burned out and angry--what blog did you think you stumbled on--the one with kitten photos? Wy do you think the blog is Medical Doctors OverDosed? And if you'd read his previous posts you'd know that "911" is a separate entity from the doctor himself, who obviously prides himself on providing compassionate care. And yes, he's a conservative, and why would a conservative start agreeing with liberal positions? I'm a liberal myself, but I haven't resorted to name-calling since I became a big girl.

911 once again you Rock!I do not know about some of you who work in "poor" hoods, but how many times have you seem :folks" like this in govt apartments with nicer stuff then you, tvs, furnature and so on while you work your butt off for what we have. I have and I know many of you have too.

If she has money for shades and a tattoo then she has bus fare to get off her ass and find a job.

I bet she has no problem taking that EBT card to Mc'D's but has a hell of a time putting in a appliciation.

Holy Hell. I swear, 911, I wish you'd lower yourself to use the goddamned shift key.

I propose that from now on, all Anonymi be referred to as "Asshat".

I question why you're letting yourself get all worked up over the opinion of some douchebag that thinks that it's OK to have children when you can't even support yourself. You know, because babies are so miraculous and they are gifts from god and all that so everyone should have one. Give me a fucking break. And how dare you refer to said blessing as an "it"? Um, because that is the proper grammatical term for the sentence, you bleeding-heart asshat.

Anyway, Asshat said, "Nothing you're doing in your ER seems to be changing the way things are going there."

Perhaps asshat needs to learn what an 'Emergency' is. Last time I checked, changing social awareness, feeding fat unemployed women, providing free childcare, and whatever else asshat thinks needs to happen to make it so that you can work at Burger King and still have two children, were not 'Emergencies'.

A critical intubation with posterior oropharygeal bleeding, now THAT's an 'Emergency'.

But whatever.

Glad you're the troll magnet now.

Try not to have a stroke.

PS: I still believe that my money should go towards making me fat, not some unemployed lazy bitch with two kids. Toodles. I'm off to go buy ice cream.

"You should be able to work at a minimum wage job and support a family of four"

For sake of argument, how about a family of five? Does that include both parents working a minimum wage job? How do you make it a reality? Increase the minimum wage (there will be fewer jobs to go around, and prices will increase. And do teenagers with part time jobs need to make enough to support a family) ? Price controls (shortages, businesses closing, lack of innovation)? Handouts (you specifically stated you don't want handouts)?

You say that it's hard for people like these two to support themselves because they're just too dumb to do anything more complex than flipping burgers. That may be true, but it is impossible to determine how much of that is due to intellectual laziness and never having to work for anything and how much is due to inborn stupidity. Mom being on SSI/disability for 17 years due to "depression" from a car accident doesn't give me the impression that she has much of a work ethic. The point (911 already said this) is that we don't know what these two are capable of, career wise, because they haven't made any effort.

Your description of Action T4 is inaccurate. The Nazi docs murdered institutionalized people with real mental and physical disabilities. It wasn't aimed at killing fat, lazy people on welfare.

You also state that 20% of the American population is obese, "proving" that ignorance about healthy eating is rampant among all economic classes. While there are obese people in every class, more of those 20% are in the lower classes than the upper (a paper by Charles L. Baum III and Christopher J. Ruhm published by the National Bureau of Economic Research indicates that weight is inversely related to socioeconomic status throughout life.)